腰椎间盘退变与腹部MRI影像学参数及体重指数的相关性

Correlation between lumbar intervertebral disc degeneration, abdominal MRI imaging parameters, and body mass index

中文关键词:  腰椎间盘退变  椎旁肌脂肪浸润程度  腹部脂肪  椎体骨质量分数  体重指数

英文关键词:Lumbar disc degeneration  Paravertebral muscle fat infiltration  Abdominal fat  Vertebral bone quality score  Body mass index

中文摘要:

  【摘要】 目的：研究腰椎间盘退变与椎旁肌脂肪浸润程度、腹部脂肪、椎体骨质量（vertebral bone quality，VBQ）评分及体重指数（body mass index，BMI）之间的相关性。方法：回顾性分析2022年8月~2023年3月在扬州大学附属苏北人民医院接受腰椎MRI检查的280例患者，男性159例，女性121例，年龄24~87岁（51.4±15.1岁）。分别将患者L4/5及L5/S1节段椎间盘按照Pfirrmann分级结果分组：Ⅱ级纳入正常组，Ⅲ~Ⅴ级纳入退变组（无Ⅰ级患者）。在MRI T2加权像上，根据改良Goutallier分级标准评估患者椎旁肌脂肪浸润程度；测量腹部脂肪相关指标，包括腹壁脊柱径（abdominal diameter，AD）、矢状直径（sagittal diameter，SAD）、腹侧皮下脂肪厚度（ventral subcutaneous thickness，VST），在L5/S1节段椎间盘后缘水平测量患者背侧皮下脂肪厚度（dorsal subcutaneous thickness，DST），内脏脂肪比率（visceral fat ratio，VFR）。在MRI TI加权像上计算VBQ评分（L1~L4椎体平均信号强度除以L3水平脑脊液的信号强度）。通过卡方检验、独立样本t检验比较两组椎旁肌脂肪浸润程度、腹部脂肪、VBQ评分及BMI之间的差异，并用Pearson、Spearman相关性分析对腰椎间盘退变与椎旁肌脂肪浸润程度、腹部脂肪、VBQ评分及BMI进行相关性分析。采用Logistic回归分析进行多因素分析，确定腰椎间盘退变相关因素的优势比（OR值）及95%置信区间（95%CI），采用受试者操作特征（receiver operating characteritics，ROC）曲线进一步分析腰椎间盘退变与椎旁肌脂肪浸润程度、腹部脂肪及VBQ评分的相关性。结果：L4/5椎间盘Pfirrmann分级Ⅱ级107例（正常组），Ⅲ~Ⅴ级173例（退变组）；L5/S1椎间盘Pfirrmann分级Ⅱ级101例（正常组），Ⅲ~Ⅴ级179例（退变组）。L4/5节段正常组与退变组椎旁肌脂肪浸润程度、AD、SAD、VFR、VBQ评分之间有统计学差异（P＜0.05），L4/5节段椎间盘退变与椎旁肌脂肪浸润程度、AD、SAD、VFR、VBQ评分成正相关（r=0.412、r=0.244、r=0.234、r=0.244、r=0.254），L4/5节段椎间盘退变与DST成负相关（r=-0.139，P＜0.05），L4/5节段椎间盘退变与BMI无相关性（P＞0.05）。L5/S1节段正常组与退变组椎旁肌脂肪浸润程度、AD、SAD、VFR、VBQ评分之间有统计学差异（P＜0.05），L5/S1节段椎间盘退变与椎旁肌脂肪浸润程度、AD、SAD、VFR、VBQ评分成正相关（r=0.424、r=0.201、r=0.150、r=0.201、r=0.205），L5/S1节段椎间盘退变与DST成负相关（r=-0.175，P＜0.05），L5/S1节段椎间盘退变与BMI无相关性（P＞0.05）。Logistic回归分析示L4/5节段椎间盘退变与SAD（OR=1.065）、DST（OR=0.904）、VBQ评分（OR=2.143）及椎旁肌脂肪浸润程度（OR=5.110）密切相关；L5/S1节段椎间盘退变与DST（OR=0.889）、椎旁肌脂肪浸润程度（OR=4.739）密切相关。结论：腰椎椎间盘退变与椎旁肌脂肪浸润程度、腹部脂肪、VBQ评分存在显著相关性。

英文摘要:

  【Abstract】 Objectives: To investigate the correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration, abdominal fat, vertebral bone quality(VBQ) score as well as body mass index(BMI). Methods: A retrospective analysis was conducted on 280 patients who underwent lumbar MRI examination at the affiliated Su Bei People′s Hospital of Yangzhou University from August 2022 to March 2023. The patients included 159 males and 121 females, with ages ranging from 24 to 87 years(51.4±15.1 years). The L4/5 and L5/S1 intervertebral discs were classified according to the Pfirrmann grading system: grade Ⅱ was included in the normal group, and grades Ⅲ-Ⅴ were included in the degeneration group (no grade Ⅰ patients). The degree of paraspinal muscle fat infiltration was evaluated based on the modified Goutallier grading system using MRI T2-weighted images. Abdominal fat indicators were measured, including abdominal diameter(AD), sagittal diameter(SAD), ventral subcutaneous thickness(VST), dorsal subcutaneous thickness(DST) at the level of the posterior margin of the L5/S1 disc, and visceral fat ratio(VFR). VBQ score was assessed using MRI T1-weighted images (the average signal intensity of L1-L4 vertebrae divided by the signal intensity of cerebrospinal fluid at L3 level). Chi-square tests and independent sample t-tests were used to compare the differences in paraspinal muscle fat infiltration, abdominal fat, VBQ scores, and BMI between the two groups. Pearson and Spearman correlation analyses were performed to examine the correlations between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration, abdominal fat, VBQ scores, and BMI. Logistic regression analysis was conducted to determine the odds ratios(OR) and 95% confidence intervals(CI) for factors related to lumbar disc degeneration. Receiver operating characteristic(ROC) curves were further used to analyze the correlation between lumbar disc degeneration and paraspinal muscle fat infiltration, abdominal fat, and VBQ scores. Results: For the L4/5 intervertebral disc, 107 cases were classified as grade Ⅱ(normal group) and 173 cases as grades Ⅲ-Ⅴ(degeneration group) according to the Pfirrmann classification; For the L5/S1 intervertebral disc, 101 cases were grade Ⅱ(normal group) and 179 cases were grades Ⅲ-Ⅴ(degeneration group). There were statistically significant differences between L4/5 intervertebral disc degeneration and the degree of paravertebral muscle fat infiltration, AD, SAD, VFR, and VBQ scores(P<0.05). L4/5 intervertebral disc degeneration was positively correlated with the degree of paravertebral muscle fat infiltration, AD, SAD, VFR, and VBQ scores(r=0.412, r=0.244, r=0.234, r=0.244, r=0.254). L4/5 intervertebral disc degeneration was negatively correlated with DST(r=-0.139, P<0.05), and there was no correlation between L4/5 intervertebral disc degeneration and BMI(P>0.05). There were statistically significant differences between L5/S1 intervertebral disc degeneration and the degree of paravertebral muscle fat infiltration, AD, SAD, VFR, and VBQ scores(P<0.05). L5/S1 intervertebral disc degeneration was positively correlated with the degree of paravertebral muscle fat infiltration, AD, SAD, VFR, and VBQ scores(r=0.424, r=0.201, r=0.150, r=0.201, r=0.205). L5/S1 intervertebral disc degeneration was negatively correlated with DST(r=-0.175, P<0.05), and there was no correlation between L5/S1 intervertebral disc degeneration and BMI(P>0.05). Logistic regression analysis showed that L4/5 disc degeneration was closely related to SAD(OR=1.065), DST(OR=0.904), VBQ score(OR=2.143), and paraspinal muscle fat infiltration(OR=5.110). L5/S1 disc degeneration was closely related to DST(OR=0.889) and paraspinal muscle fat infiltration(OR=4.739). Conclusions: Lumbar disc degeneration is significantly correlated with paraspinal muscle fat infiltration, abdominal fat, and VBQ score.